Friends or not? Navigating the therapeutic bond in music therapy within Flexible Assertive Community Treatment—A qualitative interview study

Introduction The client-therapist relationship in therapeutic work, including in music therapy, plays a crucial role in the success of mental health interventions. However, music therapy within the context of Flexible Assertive Community Treatment (FACT), a community-based mental health model, often transcends conventional boundaries of the therapeutic relationship, blending elements of professional care with a friendship-like connection. This raises ethical and practical questions about the nature and limits of therapeutic relationships. This study explores how music therapists navigate therapeutic relationships within FACT, exploring the question “Friends or not? How do music therapists in FACT reflect on boundaries in the music-therapeutic relationship?”Methods Six music therapists from different FACT teams across Norway were individually interviewed. The study employed reflexive thematic analysis to explore themes related to the personal-professional relationship and boundaries in the music-therapeutic relationship.Results Findings indicate that music therapists value the closeness and personal connection developed through music therapy within FACT, which often resembles a friendship. However, they also recognise the necessity of maintaining professional boundaries. The three analytical themes “the personal-professional relationship,” “the context of the relationship” and “acts of boundaries” explore how music therapists navigate dual relationships, handle situations where patients might misinterpret closeness as personal affection and enact professional boundaries through concrete practices.Discussion The participants highlighted the delicate balance required to maintain professionalism while engaging deeply with patients through music. The study underscores the importance of continuous self-reflection by therapists. Supervision and dialogue on ethical dilemmas within the FACT teams are warranted.